AB1745-PARE ROLE OF DIET IN INFLUENCING RHEUMATIC DISEASE ACTIVITY: A TUNISIAN PATIENTS SURVEY
Authors: S. Rekik, S. Nouicer, S. Rahmouni, K. Zouaoui, S. Boussaid, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The possible influence of diet on rheumatic disease (RD) is a controversial issue. Howerver, rheumatic patients often ask for specific diet because they experience change in joint symptoms after taken some food. Few studies have been conducted regarding patients' perceptions of the influence of diet and fasting on their RD. None of such studies have been conducted so far in countries. <h3>Objectives</h3> The main purpose of this study is to survey patients regarding diet and RD symptoms. <h3>Methods</h3> This is a survey based on a questionnaire that included patients followed for rheumatoid arthritis (RA) (ACR/EULAR 2010 criteria) and spondyloarthritis (SA) (ASAS 2009 criteria), in remission or low disease activity, who presented to the rheumatology department. We didn't include patients with inflammatory bowel or malabsoption diseases or current smokers. Socio-demographic data, co-morbidities, and data of RD (disease duration, disease activity (Disease Activity Score (DAS28) and Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP) and medication (Disease-modifying antirheumatic drugs (DMARDs)) were recorded. The questionnaire consisted of 7 major questions with variety of sub-questions. Patients were asked whether they believe diet had a major role on the RD onset, if they have experienced aggravation or improvement of their symptoms with food intake, and if the answer was yes, then they were asked to name the food item. The patients were also asked if they have changed their dietary habits since the diagnosis of RD, if they believe that healthy dietary habit may improve their disease, and if fasting relieve their disease. <h3>Results</h3> We enrolled 39 RA (34 female) and 22 SA (2 female) patients with respective mean age of 52.74±11.31 years and 54.54±11.2 years. Among patients with RA, 53.8% and 22.7% had primary school level, 45.5% of SA patients had secondary educational level. Half of RA and SA patients had comorbidities: 56.4% and 54.5% respectively. The mean disease duration was 8.68±6.6 years and 14.77±9.1 in RA and SA respectively. Half of patients (53%) with RA had obesity and overweight and 40.9 % of SA. The mean DAS28 was 2.06±0.71 and the mean ASDAS-CRP was 1.28±0.41. The majority of RA patients were on conventional synthetic DMARDs (82.1%) and SA patients on biologic (72.7%). Among RA patients, 64% believed that diet have some role in the onset of their RD and 68 % of SA. The main food incriminated were red meat in 64 % and 68%, fried food in 31% and 27% and pasta in 23% and 32% of RA and SA respectively. In addition, 84% of RA and 91 % of SA patients reported improvement of their joint disorder by consuming certain food and 90 % of RA and 91 % of SA reported aggravation of their disease. Most often the positive influence was assigned to green leavy vegetables in 74% and 86%, citrus in 67% and 77%, olive oil in 26% and 32% of RA and SA patients respectively. In our study, red meat was the major constituent of diet which aggravated the symptoms in RD as 87% and 91 % of RA and SA patients respectively, reported aggravation of symptoms with red meat. Modifying in dietary habit occurred in 12.8% of RA and 4.5% of SA to improve their disease activity. The majority of patients thought that healthy dietary habit could be a disease therapy: 94.9% of RA and 95.5 % of SA. Only 5.1% of RA patients reported receiving dietary advice from their rheumatologist and none of the SA patients, while an average of 80% of RA and SA patients showed interest in such discussion. All patients reported relief of joint symptoms after fasting Ramadan. <h3>Conclusion</h3> In this real-life population, there is an ultimate need to investigate the nutritional states in patients with RD, since certains food may improve or aggravate joint symptoms. Red meat release alert signals on RD health patients. Studies of the molecular mechanisms behind these phenomena attract increasing attention. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.